Tesis

Hubungan Nilai Transepidermal Water Loss dan Skin Capacitance dengan Derajat Keparahan Medical Adhesive Related Skin Injury pada Pasien Geriatri di Rawat Inap = Correlation between Transepidermal Water Loss and Skin Capacitance with the Severity of Medical Adhesive-Related Skin Injury in Geriatric Inpatients.

Latar belakang: Medical adhesive-related skin injury (MARSI) merupakan cedera kulit akibat penggunaan perekat medis, yang sering terjadi pada populasi geriatri karena perubahan fisiologis kulit seiring proses menua. Terdapat tiga tipe MARSI yaitu trauma mekanik, dermatitis kontak, dan tipe lainnya (maserasi dan folikulitis). MARSI dapat menambah kerusakan integritas sawar kulit. Data mengenai angka kejadian, tipe, derajat keparahan MARSI, dan parameter objektif kerusakan sawar kulit pada populasi geriatri masih terbatas. Metode: Penelitian ini menggunakan desain potong lintang untuk menilai hubungan nilai transepidermal water loss (TEWL) dan skin capacitance (SCap) dengan derajat keparahan MARSI pada pasien geriatri di ruang rawat inap Gedung A Rumah Sakit Cipto Mangunkusumo (RSCM). Pemeriksaan TEWL dan SCap dilakukan setelah 30 menit pelepasan perekat medis untuk fiksasi nasogastric tube atau indwelling urinary catheter atau central venous catheter atau peripheral intravenous dressing. Derajat keparahan MARSI dikategorikan berdasarkan temuan klinis, menjadi tanpa MARSI, MARSI derajat ringan, sedang, dan berat. Analisis statistik dilakukan untuk menilai perbedaan rerata nilai TEWL dan nilai SCap pada pasien MARSI dan tidak MARSI, serta korelasi antara nilai TEWL dan nilai SCap dengan derajat keparahan MARSI. Hasil: Didapatkan 77 lokasi pemasangan perekat medis dari 66 pasien geriatri yang menjadi subjek penelitian (SP). Kejadian MARSI ditemukan pada 27,27% lokasi, yang terdiri atas dermatitis kontak 95,24% dan trauma mekanis 33,33%, dengan derajat keparahan sedang 16,88% dan ringan 10,39%. Analisis perbedaan rerata nilai TEWL dan SCap pada kelompok MARSI dan tidak MARSI menghasilkan nilai p sebesar 0,241 dan 0,717 menggunakan uji Mann-Whitney dan uji T tidak berpasangan. Uji korelasi Spearman antara TEWL dan SCap dengan derajat keparahan MARSI menghasilkan nilai p = 0,372 dan 0,548 dengan koefisien korelasi sebesar r = -0,103 dan -0,070. Kesimpulan: Tidak terdapat perbedaan bermakna secara statistik antara rerata nilai TEWL dan Scap pada pasien geriatri dengan MARSI dan tidak MARSI.Tidak terdapat korelasi antara nilai SCap dengan derajat keparahan MARSI pada pasien geriatri di ruang rawat inap Gedung A RSCM.
Kata kunci: Geriatri, medical adhesive-related skin injury, skin capacitance, transepidermal waterloss


Background: Medical adhesive-related skin injury (MARSI) refers to skin damage caused by the application or removal of medical adhesives. It is frequently observed in the geriatric population due to age-related physiological changes in the skin. MARSI is classified into three types: mechanical trauma, contact dermatitis, and other types such as maceration and folliculitis. This condition can further compromise skin barrier integrity. However, data on the incidence, type, severity of MARSI, and objective parameters of skin barrier damage in older adults remain limited. Methods: This cross-sectional study aimed to evaluate the relationship between transepidermal water loss (TEWL) and skin capacitance (SCap) values and the severity of MARSI in hospitalized geriatric patients at Gedung A, Cipto Mangunkusumo General Hospital (RSCM), Jakarta. TEWL and SCap measurements were performed 30 minutes after the removal of medical adhesives used for securing nasogastric tubes, indwelling urinary catheters, central venous catheters, or peripheral intravenous dressings. MARSI severity was classified clinically into no MARSI, mild, moderate, or severe. Statistical analyses were conducted to assess differences in mean TEWL and SCap values between MARSI and non-MARSI groups, and to evaluate the correlation between these values and MARSI severity. Results: A total of 77 adhesive sites from 66 geriatric patients were included. MARSI occurred at 27.27% of sites, with contact dermatitis accounting for 95.24% and mechanical trauma for 33.33%. Moderate and mild MARSI were found in 16.88% and 10.39% of sites, respectively. No statistically significant differences were found in mean TEWL (p = 0.241) and SCap (p = 0.717) between MARSI and non-MARSI groups (using Mann– Whitney and unpaired t-tests, respectively). Spearman correlation tests showed no significant correlation between TEWL or SCap values and MARSI severity (p = 0.372 and 0.548; r = –0.103 and –0.070, respectively). Conclusion: There was no statistically significant difference in mean TEWL and SCap values between geriatric patients with and without MARSI. Additionally, no correlation was found between these skin barrier measurement and severity of MARSI among geriatric inpatients at Gedung A RSCM.
Keywords: Geriatrics, medical adhesive-related skin injury, skin capacitance, transepidermal water loss